| NPI | 1750676722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD451495) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT200163) |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2016-11-30 |